Treatment options exist for carpal tunnel

Dr. Gary Kronen of MidAmerica Hand to Shoulder Clinic

Handout

Handout

Bonnie Miller Rubin, Chicago Tribune reporter

A few decades ago — before computers or checkout scanners — few people had heard of a rare condition called carpal tunnel syndrome. Today, in many offices, wrist splints are as common as Post-it notes. So, how do we keep this modern problem at bay?

To learn more, we called on Dr. Gary Kronen of MidAmerica Hand to Shoulder Clinic, which has offices in Libertyville, Mokena, Oakbrook Terrace, Palos Hills and Schaumburg. The board-certified hand and plastic surgeon will be conducting a free program on the condition Wednesday from 6:30 to 7:30 p.m. at Silver Cross Hospital in New Lenox.

Q. What exactly is carpal tunnel syndrome?

A. It's the ... irritation of the median nerve in the hand and wrist. It develops over time and may be caused by repetitive motions or forceful gripping, resulting in numbness, tingling and also, but less commonly, pain. The name refers to the canal in the wrist through which the median nerve passes.

Q. How do you know if you have CTS instead of just hand pain?

A. Numbness is the hallmark. ... Some patients will come in and say they have tingling, or their hand feels like it fell asleep, but it's all the same thing. Typical symptoms are numbness in the thumb, index, middle and one half of the ring finger. Two other common nerve compressive conditions are cubital tunnel syndrome, which is compression of the ulnar nerve at the inside of the elbow, and Guyon's canal syndrome, which is caused by entrapment of the ulnar nerve as it passes through the wrist. But carpal tunnel is by far the most common.

Q. What are the symptoms?

A. People with carpal tunnel syndrome first notice tingling or numbness — especially at night. Sometimes the tingling or pain may radiate up the forearm and even into the shoulder. But if you don't have numbness, it's typically not CTS.

Q. How do you make a diagnosis?

A. You would take a history and do a clinical exam. You'd do a nerve test to confirm the diagnosis — such as an electromyogram (EMG) or nerve conduction studies — to evaluate any loss of normal functioning and check the response to electric stimulation. You might also get X-rays to ensure there's no other pathology, such as a fracture.

Q. What is the typical approach to treatment?

A. You would probably start with wearing a wrist splint at night and some home exercises, or try to change the ergonomics of your workplace. I'd try this for four to six weeks. If these more conservative measures are inadequate, we'll often consider a steroid injection. It's not a cure, but it offers temporary relief and if you respond, you're a good candidate for carpal tunnel surgery.

Q. Surgery, really? It seems so drastic.

A. Carpal tunnel responds very well to surgery. The cutting of the bandlike wrist ligament relieves pressure on the median nerve and can be done as an outpatient under local anesthetic. One of the most common mistakes is that conservative treatment gets drawn out for too long or patients continue to tolerate the tingling in order to avoid surgery. Sometimes operating is the more conservative treatment. By proceeding with earlier surgical intervention for CTS ... it would take less time for the effects of nerve compression, the numbness and tingling, to reverse itself and to potentially avoid permanent nerve damage.

Q. Can it come back?

A. Once the pressure is off the nerve, there's a minimal chance, about 5 percent. Most of the patients who have poor results did not have CTS to begin with, but arthritis, tendinitis or some other non-nerve-related problem. Making the correct diagnosis is paramount to a successful outcome after surgery.

Q. What happens if I just ignore it?

A. You can end up with hands that are weak and clumsy ... and it's often not reversible.

Q. Can I blame the computer for my stiffness and achiness?

A. Actually, there's no direct evidence that spending even eight hours a day on a keyboard leads to carpal tunnel syndrome. But certainly repetitive activities or forceful gripping can aggravate it. Use of vibratory power tools, such as jackhammers, have been shown to directly cause CTS.

Q. How can I reduce my risk?

A. Arranging your activity and work spaces using ergonomic guidelines — focusing on how your workstation is set up, including the placement of your desk, chair, computer monitor, keyboard and mouse — can all help. You can request your employer do an ergonomic assessment to alleviate the problem.

Q. Anything else?

A. Pay attention to the proper positioning of your hands and wrist ... such as not holding your wrist in a flexed position when you're typing. You can also practice good posture because slumping aggravates the nerves of the neck, which can predispose you to developing carpal tunnel.